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Flashcards in USMLE Renal Deck (62):
1

What HF drug will result in gynecomastia?

Spironolactone - similar structure to steroid

2

What drug can be added onto a HF regimen to improve survival?

Spironolactone

3

How does IL-2 suppress tumours?

Enhancing T cell and NK cell activity

4

What part of the kidney reabsorbs the most water?

Proximal tubule

5

People with upper motor neuron lesions have what kind of bladder?

Hypertonic bladder

6

Where does uric acid precipitate in the renal tubules and why?

Collecting ducts, b/c of low urine pH

7

How are particles filtered in the glomeruli?

By size (fenestrated capillaries) and by charge (heparan sulfate in the BM)

8

How do you calculate renal clearance?

Cx = Ux*V/Px

9

How do you calculate filtered load?

Filtered load = GFR x Px

10

How do you calculate excreted load?

Excreted load = Ux * V

11

What is the Potter Sequence?

Pulmonary hypoplasia
Oligohydramnios
Twisted face
Twisted skin
Extremity defects
Renal failure in utero

12

If one baby has a dysplastic kidney, what's the risk of subsequent children having one as well?

Relatively low, not inherited.

13

If a newborn has the Potter sequence, what condition do you suspect?

ARPKD

14

If a newborn has signs and sx of portal HTN, what condition do you think of?

ARPKD

15

If patient presents with fam hx of renal failure and death from brain hemorrhage/renal failure, what condition do you think of?

ADPKD

16

How do you differentiate prerenal from renal acute kidney injury?

BUN:creatinine ratio goes up in prerenal, down in renal.

17

How does the BUN:creatinine ratio change in early and late postrenal kidney injury?

Rises then falls as tubules get damaged.

18

If a patient with AKI has oxalate crystals in their urine, what do you think of?

Ethylene glycol poisoning leading to nephrotoxic (vs ischemic) ATN

19

Patient with fever, rash, hematuria, and eosinophils on urine. Dx?

Acute Interstitial Nephritis

20

Minimal change disease is associated with what other disease?

Hodgkin's Lymphoma

21

What are the risk factors for FSGS?

Heroin use, sickle cell disease, HIV infxn

22

FSGS is the most common cause of nephrotic syndrome in what kinds of people?

Black and Hispanic

23

Membranous is the most common cause of nephrotic syndrome in what kinds of people?

Caucasian adults

24

Minimal change disease is the most common cause of nephrotic syndrome in what kinds of people?

Children

25

What kind of nephrotic and nephritic syndromes do SLE patients present with?

Membranous nephropathy, Diffuse proliferative glomerulonephritis

26

Granular immunofluorescence points towards what kind of nephropathy?

Membranous nephropathy b/c it signifies immune complex deposition

27

What does tram track appearance on PAS stain point towards?

Membranoproliferative glomerulonephritis

28

What is Type I membranoproliferative glomerulonephritis associated with?

HCV
HBV
Tram track

29

What is Type II membranoproliferative glomerulonephritis associated with?

C3 nephritic factor, which stabilizes C3 convertase, decreases C3 levels

30

What is the first change in the kidneys in diabetes?

Non enzymatic glycosylation of the GBM

31

What feature in the kidneys is pathognomonic for diabetes?

Kimmelstiel Wilson lesions

32

What defines nephritogenic strains of group A strep?

M protein virulence factor

33

Subepithelial hump in EM. Dx?

Poststrep GN

34

Periorbital edema, cola-coloured urine, HTN. Dx?

Poststrep GN

35

In RPGN, what are the crescents on biopsy made up of?

Fibrin and macrophages

36

Patient presents with hematuria, hemoptysis, and have RPGN with sinusitis. Dx?

Wegener's granulomatosis (w/ +ve c-ANCA)

37

Patient presents with hematuria, hemoptysis, and have RPGN. Dx?

Goodpasture's Syndrome

38

Patient presents with isolated hematuria, sensory hearing loss and eye problems with positive fam hx. Dx?

Alport syndrome.

39

What kind of stone typically develops from an ammonium Mg phosphate stone?

Staghorn calculi

40

What is important to exclude with hypercalciuria?

Hypercalcemia

41

What does being on dialysis in end stage renal failure increase the risk of?

RCC

42

What are angiomyolipomas associated with?

Tuberous sclerosis

43

What is the triad associated with RCC?

Hematuria
Palpable mass
Flank pain

44

What paraneoplastic syndromes are associated with RCC?

ACTH (Cushing's)
Epo (2ndary polycythemia)
PTHrP
Renin (HTN)

45

What do you think of if you see a left-sided varicocele?

RCC

46

Pathogenesis of RCC involves loss of what gene?

VHL on chromosome 3

47

What is the key component of Wilms tumour?

Blastema

48

What are the risk factors for urothelial carcinoma?

Smoking (Naphthylamine and polycyclic aromatic HCs)
Azo dyes
Long term cyclophosphamide and phenacetin

49

Flat urothelial carcinomas are associated with...

Early p53 mutations

50

Middle Eastern male presents with painless hematuria. Dx?

Squamous cell carcinoma of the bladder secondary to schistosoma infection

51

What kind of cancer with urachal remnants?

Bladder adenocarcinoma on the dome of the bladder

52

Patients with angiomyolipomas also have what findings?

Brain hamartomas and ash-leaf skin patches as a result of tuberous sclerosis

53

Calcium kidney stones typically lead to what Ca levels in blood and urine?

Normocalcemia, hypercalciuria

54

What are important factors to check in the differential of metabolic alkalosis?

Volume status and urine chloride

55

What drug should you check for before giving ACEi and why?

Thiaizide or loop diuretics b/c of potential first dose hTN

56

How do you calculate net filtration pressure?

(Hydrostatic of Glomerulus - Hydrostatic of Bowman) - (Oncotic of Glomerulus - Oncotic of Bowman)

57

A man treated for sinusitis with ampicillin later presents with oliguria, rash, fever. What does he have?

AIN

58

What cells are Epo released from?

Interstitial cells of peritubular capillary bed

59

Why does the BUN rise in prerenal AKI?

Because kidneys reabsorb H2O, Na, and BUN to raise volume

60

How do you prevent Ca stones from precipitating?

By adding citrate

61

What does ANCA stand for?

Anti neutrophil cytoplasmic antibodies

62

What kidney disease is MPLAR-2 associated with?

Membranous nephropathy